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54 〈51〉 Antimicrobial Effectiveness Testing / Microbiological Tests USP 35

Table 3. Criteria for Tested Microorganisms of plates for each aliquot. Place 1.0 mL of each selected
dilution in each of two 15- × 100-mm Petri dishes. Within
For Category 1 Products 20 minutes, add to each plate 20 mL of Soybean–Casein
Bacteria: Not less than 1.0 log reduction from Digest Agar Medium that has been melted and cooled to
the initial calculated count at 7 days, 45° to 50°. Swirl to attain a homogeneous suspension, and
not less than 3.0 log reduction from allow it to solidify. Incubate the plates in an inverted posi-
the initial count at 14 days, and no tion at 55° to 60° for Biological Indicator for Steam Steriliza-
increase from the 14 days’ count at tion, Paper Carrier, and at 30° to 35° for Biological Indicator
28 days. for Ethylene Oxide Sterilization, Paper Carrier and for Biological
Yeast and Molds: No increase from the initial calculated Indicator for Dry-Heat Sterilization, Paper Carrier or at the op-
count at 7, 14, and 28 days. timal recovery temperature specified by the manufacturer.
For Category 2 Products Examine the plates after 24 and 48 hours, recording for
Bacteria: Not less than 2.0 log reduction from each plate the number of colonies; and use the number of
the initial count at 14 days, and no colonies observed after 48 hours to calculate the results.
increase from the 14 days’ count at Calculate the average number of spores per specimen from
28 days. the results, using the appropriate dilution factor. The test is
Yeast and Molds: No increase from the initial calculated
valid if the log number of spores per carrier at 48 hours is
count at 14 and 28 days.
equal to or greater than the log number after 24 hours in
each case. For Biological Indicator for Steam Sterilization, Self-
For Category 3 Products Contained, aseptically remove the three carriers from the
Bacteria: Not less than 1.0 log reduction from container, and proceed as directed for Biological Indicator for
the initial count at 14 days, and no Steam Sterilization, Paper Carrier.
increase from the 14 days’ count at For Biological Indicators for Moist Heat, Dry Heat, and Gase-
28 days. ous Modes of Sterilization, Nonpaper Carriers, aseptically re-
Yeast and Molds: No increase from the initial calculated move the three carriers from their original packaging or
count at 14 and 28 days. container. Place each carrier in a suitable sterile container
For Category 4 Products containing 100 mL of chilled Purified Water, and sonicate or
Bacteria, Yeast, No increase from the initial calculated shake on a reciprocal shaker for an appropriate time. Fifteen
and Molds: count at 14 and 28 days. minutes or more may be required for optimal recovery. A
previous study should be conducted that ensures that the
recovery method results in at least 50% to 300% recovery
of the labeled spore viable count. Transfer a 10-mL aliquot
of the suspension to a sterile, screw-capped 16- × 125-mm
tube. Heat the tubes containing suspensions of Bacillus
atrophaeus, Bacillus subtilis, and Bacillus coagulans at 80° to
85° for 10 minutes. Heat the tubes containing a suspension
〈55〉 BIOLOGICAL INDICATORS— of Geobacillus stearothermophilus at 95° to 100° for 15 min-
utes. Start the timing when the lowest temperature of the
RESISTANCE PERFORMANCE stated temperature ranges is reached. Cool rapidly in an ice-
water bath at 0° to 4°. Transfer two 1-mL aliquots to suita-
TESTS ble tubes, and make appropriate serial dilutions in Purified
Water. The selected dilutions should be those that will pref-
erably yield 30 to 300 colonies but not fewer than 6 on
each pair of plates when treated as described below. When
the biological indicator has a low spore concentration, it
may be necessary to modify the dilution series and to use
TOTAL VIABLE SPORE COUNT more plates at each dilution. Prepare a separate series of
plates for each aliquot. Place 1.0 mL of each selected dilu-
For paper carrier biological indicators, remove three speci- tion in each of two 15- × 100-mm Petri dishes. Within 20
mens of the relevant biological indicators from their original minutes add the aliquot to each plate containing 20 mL of
individual containers. Disperse the paper into component fi- agar that has been melted and cooled to between 45° and
bers by placing the test specimens in a sterile 250-mL cup 50°. Swirl to attain a homogeneous suspension.
of a suitable blender containing 100 mL of chilled, sterilized For G. stearothermophilus, B. atrophaeus, B. subtilis, and B.
Purified Water and blending for a time known to be ade- coagulans, use Soybean–Casein Digest Agar Medium and incu-
quate to achieve a homogeneous suspension. It is not unu- bate the plates in an inverted position aerobically at the
sual for blending times of 15 minutes or more to be re- following respective temperatures for each microorganism:
quired for optimal recovery. Transfer a 10-mL aliquot of the 55° to 60°, 30° to 35°, and 48° to 52°, or at the optimum
suspension to a sterile, screw-capped 16- × 125-mm tube. temperature specified by the biological indicator manufac-
For Biological Indicator for Steam Sterilization, Paper Carrier, turer. Examine the plates after 24 and 48 hours. Record the
heat the tube containing the suspension in a water bath at number of colonies observed on each plate. Calculate the
95° to 100° for 15 minutes (heat shock), starting the timing average number of spores per carrier from the results, using
when the temperature reaches 95°. For Biological Indicator the appropriate dilution factor. The test is valid if the log
for Dry-Heat Sterilization, Paper Carrier, and for Biological Indi- number of spores per carrier at 48 hours is equal to or
cator for Ethylene Oxide Sterilization, Paper Carrier, heat the greater than the log number after 24 hours in each case.
tube containing the suspension in a water bath at 80° to For Biological Indicators for Moist Heat, Dry Heat, and Gase-
85° for 10 minutes, starting the timing when the tempera- ous Modes of Sterilization, Liquid Spore Suspensions, using G.
ture of the spore suspension reaches 80°. Cool rapidly in an stearothermophilus, B. atrophaeus, B. subtilis, and B. coagulans
ice-water bath at 0° to 4°. Transfer two 1-mL aliquots to as biological indicators, prepare an appropriate serial dilu-
suitable tubes, and make appropriate serial dilutions in steril- tion of the original spore suspension in chilled Purified Water
ized Purified Water, the dilutions being selected as calculated contained in a sterile, screw-capped 16- × 125-mm tube,
to yield preferably 30 to 300 colonies, but not less than 6, and proceed with the viable spore count procedures speci-
on each of a pair of plates when treated as described below. fied under Biological Indicators for Moist Heat, Dry Heat, and
Where the biological indicator has a low spore concentra- Gaseous Modes of Sterilization, Nonpaper Carriers.
tion, it may be necessary to modify the dilution series and
to use more plates at each dilution. Prepare a separate series

Official from May 1, 2012


Copyright (c) 2011 The United States Pharmacopeial Convention. All rights reserved.
Accessed from 128.83.63.20 by nEwp0rt1 on Thu Dec 01 21:53:06 EST 2011

USP 35 Microbiological Tests / 〈55〉 Biological Indicators—Resistance Performance Tests 55

D-VALUE DETERMINATION turer for each sterilization method. It is possible that biologi-
cal indicators inoculated onto carriers other than paper will
Conduct all the tests described in this section under asep- be used for gaseous or vapor sterilization/decontamination
tic conditions, using sterilized equipment for nonthermo- methods such as vapor phase hydrogen peroxide and chlo-
philic microorganisms. D-value determination for G. rine dioxide.
stearothermophilus and B. coagulans can be performed in a Standard physical conditions for the evaluation of biologi-
controlled but unclassified environment. cal indicators for use with vapor phase hydrogen peroxide
or chlorine dioxide have not been defined. In the case of
chlorine dioxide, concentration of the gas, relative humidity,
Apparatus and temperature are critical process control conditions that
can be accurately measured. The manufacturer of biological
The test equipment for the determination of microbial re- indicators marketed for use with chlorine dioxide should
sistance is described in substantial detail in ISO 18472, Ster- state the conditions under which the D-value determination
ilization of Health Care Products—Biological and Chemical In- was conducted so that the user can at least discern the
dicators—Test Equipment.1 The details of individual Biological resistance of a lot of biological indicators as compared to
Indicator Evaluation Resistometers (BIERs) vary with the spe- their own anticipated use conditions. The situation with va-
cifics of their design and the particular sterilization process por phase hydrogen peroxide is a more complex one. Vari-
in conjunction with which they are used. Provided that the ous equipment manufacturers have proposed different de-
performance of the BIER vessel meets the requirements of contamination or sterilization conditions. Thus, there is no
the ISO standard for exposure of the biological indicator, standard process for the conduct of vapor phase hydrogen
design differences are acceptable. decontamination or surface sterilization. It follows, then,
that there are no industry standard biological indicator eval-
uation methods for vapor hydrogen peroxide, and it has
Procedure been reported that there may not be a direct correlation
between vapor concentration and rate or even effectiveness
Carry out the tests for D value at each of the applicable of biological indicator inactivation. Additionally, it is difficult
sets of sterilization conditions for which the packaged bio- to accurately assess relative humidity, which is often defined
logical indicator under test is labeled for use. Take a suffi- as a critical process parameter, in the presence of vapor hy-
cient number of groups of specimens of biological indicators drogen peroxide. For these reasons it is more reasonable to
in their original individual containers, each group consisting consider resistance of biological indicators to be a relative or
of not less than 5 specimens. The number of groups pro- comparative measure from the manufacturer rather than a
vides a range of observations from not less than one labeled true D value. It follows that, depending upon equipment
D value below the labeled survival time through not less and processes employed, it may be impossible for an end
than one labeled D value above the labeled kill time. Place user to duplicate the biological indicator resistance tests per-
each group on a separate suitable specimen holder that per- formed by the manufacturer.
mits each specimen to be exposed to the prescribed steril- For Biological Indicators for Moist Heat, Dry Heat, and Gase-
izing condition at a specific location in the sterilizing cham- ous Modes of Sterilization, Liquid Spore Suspensions, conduct
ber of the BIER. Check the BIER apparatus for operating D-value determinations for each of the microorganisms that
parameters using specimen holders without specimens. Se- are provided as a liquid spore crop suspension. The test is
lect a series of sterilizing times in increments from the short- conducted using appropriate serial dilutions predicated
est time for the specimens to be tested. The differences in upon the stated spore titer of the suspension in Purified
sterilizing times over the series are as constant as feasible, Water in a sterile tube.
and the difference between adjacent times is no greater Where the suspension is placed on or in a substrate such
than 75% of the labeled D value. as an elastomeric closure or formulated product, its resis-
Test procedures for the use of BIER vessels for the evalua- tance may differ from that determined in Purified Water.
tion of microbial resistance are defined in a series of ISO That difference may be significant to the usage of the bio-
standards under the 11138 series.2, 3, 4, 5 The appropriate logical indicators and appropriate measurements made prior
standard should be followed for the biological indicator. The to use in sterilization validation activities.
test methods and carriers used with the BIER may be
adapted to the specifics of the biological indicator. The
method and apparatus used for paper carriers may differ Recovery
from those for other carriers and will be substantially differ-
ent from those used for suspensions of biological indicators. After completion of the sterilizing procedure for Biological
The D-value exposure conditions for alternative material Indicator for Dry-Heat Sterilization, Paper Carrier; Biological In-
carriers are the same as the conditions used to determine dicator for Ethylene Oxide Sterilization, Paper Carrier; or Bio-
the D value for paper carriers. If the manufacturer’s label logical Indicator for Steam Sterilization, Paper Carrier, which-
permits usage of the biological indicator carrier with multi- ever is applicable, and within a noted time not more than 4
ple sterilization methods, then data on D value, survival hours, aseptically remove and add each strip to a suitable
time, and kill time will need to be provided by the manufac- medium (see Media under Sterility Tests 〈71〉) to submerge
1ANSI/ AAMI/ ISO 18472:2006, Sterilization of Health Care Products—Biologi-
the biological indicator completely in a suitable tube. For
cal and Chemical Indicators—Test Equipment. Association for the Advance- each Biological Indicator for Steam Sterilization, Self-Contained
ment of Medical Instrumentation (AAMI), 1110 N. Glebe Road, Suite 220, specimen, the paper strip is immersed in the self-contained
Arlington, VA 22201-4795 medium according to manufacturers’ instructions, within a
2ANSI/AAMI/ISO 11138-1:2006, Sterilization of health care products—Biologi-

cal indicators—Part 1: General requirements, 2nd ed. Association for the Ad- noted time not more than 4 hours. Incubate each tube at
vancement of Medical Instrumentation (AAMI), 1110 N. Glebe Road, Suite the optimal recovery temperature specified by the manufac-
220, Arlington, VA.
3ANSI/AAMI/ISO 11138-2:2006, Sterilization of health care products—Biologi-
turer. Observe each inoculated medium-containing tube at
cal indicators—Part 2: Biological indicators for ethylene oxide sterilization
appropriate intervals for a total of 7 days after inoculation.
processes, 3rd ed. Association for the Advancement of Medical Instrumenta- (Where growth is observed at any particular observation
tion (AAMI), 1110 N. Glebe Road, Suite 220, Arlington, VA. time, further incubation of the specimen(s) concerned may
4ANSI/AAMI/ISO 11138-3:2006, Sterilization of health care products—Biologi-
be omitted.) Note the number of specimens showing no
cal indicators—Part 3: Biological indicators for moist heat sterilization
processes. Association for the Advancement of Medical Instrumentation evidence of growth at any time.
(AAMI), 1110 N. Glebe Road, Suite 220, Arlington, VA. For Biological Indicators for Moist Heat, Dry Heat, and Gase-
5ANSI/AAMI/ISO 11138-4:2006, Sterilization of health care products—Biologi-
ous Modes of Sterilization, Nonpaper Carriers, recovery of
cal indicators—Part 4: Biological indicators for dry heat sterilization processes. spores from the biological indicator carriers will follow re-
Association for the Advancement of Medical Instrumentation (AAMI), 1110 N.
Glebe Road, Suite 220, Arlington, VA. covery procedures described in the procedures under Total

Official from May 1, 2012


Copyright (c) 2011 The United States Pharmacopeial Convention. All rights reserved.
Accessed from 128.83.63.20 by nEwp0rt1 on Thu Dec 01 21:53:06 EST 2011

56 〈55〉 Biological Indicators—Resistance Performance Tests / Microbiological Tests USP 35

Viable Spore Count. D-value determination methods for pa-


per carrier biological indicators may be used to calculate the 〈61〉 MICROBIOLOGICAL
D value for nonpaper carriers. Incubation conditions for the
microorganisms that may be used for nonpaper biological EXAMINATION OF NONSTERILE
indicators are described in the Total Viable Spore Count
section. PRODUCTS: MICROBIAL
For Biological Indicators for Moist Heat, Dry Heat, and Gase-
ous Modes of Sterilization, Liquid Spore Suspensions, the ENUMERATION TESTS
method of recovery following sterilization exposure condi-
tions are those methods described in the Total Viable Spore
Count section for liquid suspensions, and when a dry heat
D-value determination is made from B. atrophaeus suspen-
sions, the same recovery procedures as described under Bio- INTRODUCTION
logical Indicator for Steam Sterilization, Paper Carrier are
followed. The tests described hereafter will allow quantitative enu-
Where C. sporogenes is used as a biological indicator, meration of mesophilic bacteria and fungi that may grow
methods for preparation, inoculation, and recovery methods under aerobic conditions.
and media must be adapted to accommodate the use of The tests are designed primarily to determine whether a
this anaerobic sporeformer. substance or preparation complies with an established speci-
fication for microbiological quality. When used for such pur-
poses, follow the instructions given below, including the
Calculation number of samples to be taken, and interpret the results as
stated below.
The determination of D values of biological indicators can The methods are not applicable to products containing
be performed using the Limited Spearman-Karber, Survival viable microorganisms as active ingredients.
Curve Method or Stumbo-Murphy-Cochran procedures.6, 7, 8 Alternative microbiological procedures, including auto-
It is preferable to use the same method as that defined by mated methods, may be used, provided that their equiva-
the biological indicator manufacturer to determine D values. lence to the Pharmacopeial method has been demonstrated.
The use of a different method can result in differences that
are more an artifact of the method than a variation in the
performance of the biological indicator. GENERAL PROCEDURES
Carry out the determination under conditions designed to
Survival Time and Kill Time avoid extrinsic microbial contamination of the product to be
examined. The precautions taken to avoid contamination
Take two groups, each consisting of 10 specimens of the must be such that they do not affect any microorganisms
relevant biological indicator, in their original, individual con- that are to be revealed in the test.
tainers. Place the specimens of a group in suitable specimen If the product to be examined has antimicrobial activity,
holders that permit each specimen to be exposed to the this is, insofar as possible, removed or neutralized. If inac-
sterilizing conditions at a specific location in the BIER tivators are used for this purpose, their efficacy and their
chamber. absence of toxicity for microorganisms must be
Expose the specimens for the required survival time, enter demonstrated.
the chamber, and remove the holder(s) containing the 10 If surface-active substances are used for sample prepara-
specimens. Repeat the above procedure immediately, or tion, their absence of toxicity for microorganisms and their
preheat if a substantial interval has elapsed, so as to subject compatibility with any inactivators used must be
the second holder(s) containing 10 specimens similarly to demonstrated.
the first conditions, but for the required kill time.
The Survival time and kill time for all monographed biolog-
ical indicators is described in the official monograph under ENUMERATION METHODS
the heading for each.
6 Pflug, I.J. Syllabus for an Introductory Course in the Microbiology and Engineer- Use the Membrane Filtration method or one of the Plate-
ing of Sterilization Processes, 4th ed. St. Paul, MN: Environmental Sterilization Count Methods, as directed. The Most-Probable-Number
Services, 1980. (MPN) Method is generally the least accurate method for
7 Pflug, I.J., and G.M. Smith. The Use of Biological Indicators for Monitoring

Wet-Heat Sterilization Processes, in Sterilization of Medical Products, ed. E.R.L. microbial counts; however, for certain product groups with
Gaughran and K. Kereluk. New Brunswick, NJ: Johnson and Johnson, 1977, very low bioburden, it may be the most appropriate
193–230.
8 Holcomb, R.G., and I.J. Pflug. The Spearman-Karber Method of Analyzing
method.
Quantal Assay Microbial Destruction Data, in Microbiology and Engineering
The choice of a method is based on factors such as the
Sterilization Processes, ed. I.J. Pflug. St. Paul, MN: Environmental Sterilization nature of the product and the required limit of microorgan-
Services, 1979. isms. The method chosen must allow testing of a sufficient
sample size to judge compliance with the specification. The
suitability of the chosen method must be established.

GROWTH PROMOTION TEST, SUITABILITY


OF THE COUNTING METHOD AND NEGATIVE
CONTROLS

General Considerations
The ability of the test to detect microorganisms in the
presence of product to be tested must be established.

Official from May 1, 2012


Copyright (c) 2011 The United States Pharmacopeial Convention. All rights reserved.

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